Department of Nephrology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
Critical Care Center, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
BMC Nephrol. 2024 Sep 12;25(1):303. doi: 10.1186/s12882-024-03746-0.
Bromadiolone is a wide-use long-acting anticoagulant rodenticide known to cause severe coagulation dysfunction. At present, there have been no detailed reports of acute kidney injury (AKI) resulting from bromadiolone poisoning.
A 27-year-old woman was admitted to the hospital due to severe coagulopathy and severe AKI. Coagulation test revealed a prothrombin time exceeding 120 s and an international normalized ratio (INR) greater than 10. Further examination for coagulation factors showed significantly reduced level of factors II, VII, IX and X, indicating a vitamin K deficiency. The AKI was non-oliguric and characterized by gross dysmorphic hematuria. Following the onset of the disease, the patient's serum creatinine rose from 0.86 to 6.96 mg/dL. Suspecting anticoagulant rodenticide poisoning, plasma bromadiolone was identified at a concentration of 117 ng/mL via gas chromatography/mass spectrometry. All other potential causes of AKI were excluded, except for the presence of a horseshoe kidney. The patient's kidney function fully recovered after the coagulopathy was corrected with high doses of vitamin K and plasma transfusion. At a follow-up 160 days post-discharge, the coagulation function had normalized, and the serum creatinine had returned to 0.51 mg/dL.
Bromadiolone can induce AKI through a severe and prolonged coagulation disorder. Kidney function can be restored within days following treatment with high-dose vitamin K1.
溴敌隆是一种广泛使用的长效抗凝血灭鼠剂，已知会导致严重的凝血功能障碍。目前，尚无溴敌隆中毒导致急性肾损伤（AKI）的详细报道。
一名 27 岁女性因严重凝血功能障碍和严重 AKI 入院。凝血试验显示凝血酶原时间超过 120s，国际标准化比值（INR）大于 10。进一步检查凝血因子显示因子 II、VII、IX 和 X 水平显著降低，表明维生素 K 缺乏。AKI 是非少尿型，表现为大量形态异常血尿。发病后，患者血清肌酐从 0.86mg/dL 上升至 6.96mg/dL。怀疑抗凝灭鼠剂中毒，通过气相色谱/质谱法鉴定血浆溴敌隆浓度为 117ng/mL。除马蹄肾外，排除了 AKI 的所有其他潜在原因。在高剂量维生素 K 和血浆输注纠正凝血功能障碍后，患者的肾功能完全恢复。出院后 160 天随访时，凝血功能已恢复正常，血清肌酐恢复至 0.51mg/dL。
溴敌隆可通过严重和持久的凝血障碍引起 AKI。在高剂量维生素 K1 治疗后，肾功能可在数天内恢复。
